Simplified Gastric Bypass

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Simplified Gastric Bypass

Postby Dr. Arturo » Tue Jun 30, 2009 8:27 am

Simplified Gastric Bypass

What is the Simplified Gastric Bypass?
The Gastric Bypass is considered by the American Society of Metabolic and Bariatric Surgeons (ASMBS) and the American National Institutes of Health as the gold standard of weight loss surgery.
The Gastric Bypass is also considered by the SAGES and ASMBS the most complex procedure to be done by laparoscopy.
The technique was developed by Dr. Almino Ramos in Sao Paulo, Brazil and called Simplified Laparoscopic Gastric Bypass consisting in simplifying and standardizing the surgical steps of the traditional Gastric bypass in a way that it can be done easily with less operative time (average of 75minutes) and with more efficiency (now days thousands of patients are operated by this technique all over the world).

The gastroplasty (the pouch) with an intestinal Bypass can be done by laparoscopy or by open surgery. This technique involves a gastric stapling and division of the stomach (forming the gastroplasty or a new gastric chamber or a pouch) reducing the gastric capacity in 90% (20-30cc) and a intestinal bypass with 1, 5 to 2m (the small bowel has 4 to 7m in length), at the end of the procedure the gastroplasty is communicated with the deviated small bowel (gastrojejunostomy) by the means of stapling and suturing to allow the food to pass again.

Who should have the Gastric Bypass done?
Despites the indication for bariatric surgery the Bypass have its remarks.
Bypass fits to / combines with...
- Sweet eaters
- Any degree of binging eaters
- Moderate risk patients
- High expectations / needs to loose weight
- Low / moderate patient commitment
- Not that close follow-up
- Total Patient Care (T.P.C.) at the beginning
- Up to 80% EWL (excess weight loss)

How does it Works?
This kind of operation mix restriction with malabsorption.
The restriction is predominant over malabsorption and the gastrojejunostomy is calibrated to 11mm.
The food arrives at the new stomach (gastroplasty) and promotes distention on the walls of this pouch inducting satiety and fullness with small amounts of food. Then the food passes slowly trough the calibrated gastrojejunostomy and goes to make the digestion 1, 5 to 2m after the pouch on the bypass.
If the restriction caused by the small chamber is exceeded the fullness sensation will get worse and vomiting can occur.
If the patient continues or initiate drinking liquids with high concentration of carbs it will won’t be totally absorbed and can causes bowel irritation leading to abdominal pain and diarrhea.

How is the post-op?
Most of our patients are discharged from the hospital within 48 to 72 hours after the operation.
During 4 weeks they will go on a liquid diet and advance in a stepwise way to a puree/baby food type diet for one or two additional weeks and evolving to an almost normal diet after that.
The complete return to normal activities occurs in about one week. In this operation there is a need to supplement vitamins and minerals. Iron must be followed by regular I.V. tests and reposition is usually needed

What are the results in weight loss with the Gastric bypass?
With the Gastric bypass, the mean % of excess weight loss is about 70 to 85% and reached during the first and second year after surgery.

What are the risks in gastric bypass surgery?
International literature describes an average of 10% in complications and a mortality rate between 1 and 2%. Our numbers goes to a 7, 5% complication rate and 0, 2% overall mortality rate with no deaths in the last 1000 cases of this series.
Arturo Rodriguez, MD
phone: 011 52 818 3783177
Dr. Arturo
Posts: 81
Joined: Thu Feb 19, 2009 11:02 pm
Location: Monterrey, NL. Mexico

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